The goal of this proposal is to identify factors which determine the cost of liver transplantation. Our center has participated in the NIDDK Liver Transplant Database (LTD), a five year project which has prospectively collected detailed clinical data on 919 consecutive liver transplants performed at three major centers. By merging a resource utilization database with the LTD, important information regarding the determinants of the cost of liver transplantation will be obtained. The specific aims of this project are: 1) To develop mathematical models which predict the cost of orthotopic liver transplantation (OLT) based on the recipient's pre-transplant clinical and demographic profile 2) To determine the impact of different organ allocation schemes on the cost of liver transplantation. Three strategies will be employed to analyze the data. Once the cost data has been merged with the clinical data, univariate and multi-variate analyses will be performed to identify clinical features which are associated with increased cost of OLT. Second, models will be constructed which can predict the cost of OLT based on a specific clinical profile. Finally, using these models, we will determine the economic impact of different schemes of organ allocation. These studies will provide important insights into this costly yet effective therapy for end-stage liver disease. By understanding the factors that influence costs we hope to be able to better evaluate new therapies, evaluate and modify our current system of organ allocation, and make liver transplantation more cost effective.